Agenda Item No
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health) : 11th February, 2013
Report of the Director of Social Services
Delivering the Mental Health (Wales) Measure 2010 to Meet the Needs of Local People (Update Report)
Purpose of the Report
1. To provide Scrutiny Committee with an update on how the Vale of Glamorgan Council and the Cardiff and Vale University Health Board are implementing the Mental Health (Wales) Measure 2010.
1. That Scrutiny Committee notes the content of this report.
Reason for the Recommendation
1. To ensure effective scrutiny of the way in which Mental Health (Wales) Measure 2010 is being implemented in the Vale of Glamorgan, to improve the services offered to residents who have mental health problems.
2. The Mental Health (Wales) Measure 2010 introduced a number of important changes to the way in which people with mental health problems are assessed and treated. The Measure is divided into six parts and two schedules. Parts 1 to 4 setting out the main legislative requirements relating to the provision of mental health services in Wales.
3. Part 1 came into force on 1st October 2012 and recognises the role that Primary Care plays in delivering effective mental health services. It seeks to ensure that local authorities and local health boards work in partnership to deliver Local Primary Mental Health Services within or alongside existing GP practices. These services are aimed at people of all ages who are experiencing either mild to moderate or stable, severe and enduring mental health problems.
4. Part 2 builds on the Care Programme Approach (CPA: a system for managing individual patient care in the community). It placed a duty on service providers, local authorities and local health boards to work together in a coordinated manner to improve the effectiveness of mental health services. Regulations made under Part 2 (The Mental Health (Care Coordination and Care and Treatment Planning) (Wales) Regulations 2011) prescribe the content and form of the Care and Treatment Plan which all care coordinators were required to use from 6th June 2012.
5. Part 3 enables eligible adults who have been discharged from secondary mental health services to be able to refer themselves directly to secondary mental health services without first having to go through primary care. It requires local authorities and local health boards to have arrangements in place for the timely assessment of former users of secondary mental health services, again from 6th June 2012.
6. Part 4 introduces an expanded statutory right to Independent Mental Health Advocacy to all patients subject to compulsion under the Mental Health Act 1983 (3rd January 2012) and to all voluntary mental health in-patients from 2nd April 2012.
Implementation of the Mental Health (Wales) Measure
7. As reported to Scrutiny Committee on previous occasions, collaboration in delivering mental health services is one of the four priority workstreams managed by the Integrating Health and Social Care Services Programme Board. In the Vale of Glamorgan, mental health services for adults in the community are delivered through multi-disciplinary Community Mental Health Teams (CMHTs). These teams provide health services and social care services from the same sites and they are in place across the Vale of Glamorgan and Cardiff. A new management structure has been implemented for adult mental health services and the two local authorities share an Operational Manager post. This post is hosted by the Vale of Glamorgan and Andy Cole provides strategic management on behalf of both authorities. A model for integrated team management has been implemented.
8. In patnership with the two local authorities, the Cardiff and Vale University Health Board is taking the lead in implementing all parts of the Measure. As indicated in the structural chart below, a planning and management steering group has been set up; it has representation from the UHB, the two local authorities and Primary Care.
[View Structural Chart]
9. Part 1 – The Part 1 Implementation Lead/Service Manager is in post and acts as project manager for this workstream. Building on existing relationships with GPs and primary care counselling services, an assessment and intervention model has been agreed by the steering group and Welsh Government rates it as one of the best models in Wales.
10. The Part 1 Primary Care mental health assessment service aims to promote good mental health in the population by:
making information easily available;
supporting the development of self-help groups; and
offering advice and signposting where appropriate in an open access Foundation Level.
11. Tier 1 assessments are made available through GPs, providing rapid assessment and low intensity interventions that aim to help people recover from their mild/moderate mental health problem without the need of secondary mental health care.
12. The following staffing numbers and NHS pay bandings are proposed for the Primary Mental Health Support Service (PMHSS):
Service Manager: Band 8a
Vale of Glamorgan Locality: Band 7 x 1
Band 6 x 1.6
Band 3 x 1
Administration: Band 3 x 1
[View Referral Pathway]
13. Part 2 – The Care and Treatment Plan is programmed into the Vale's SWIFT electronic case management database and the UHB's PARIS system, with links from a revised assessment form which includes the requirements of both the Care Programme Approach and Unified Assessment. The Welsh Government requires monthly data that captures the number of Care and Treatment Plans (C&T) undertaken. By November 2012, 1356 C&T Plans had been completed from a total of 5765 people receiving secondary mental health care. The Welsh Government has stated that, by 6th June 2013, all service users and patients known to secondary mental health services should have a named care coordinator and an up to date C&T Plan. A large proportion of the 5765 are patients whose cases are open to community psychiatrists but who otherwise are not known to the CMHTs. The Cardiff and Vale UHB has decided that anyone known to a psychiatrist should be classified as receiving secondary mental health care and, as such, should have an up-to-date C&T Plan. This is proving a challenging task for the community psychiatrists.
14. Abertawe Bro Morgannwg Health Board currently provides these services to people living in the Western Vale and it has taken a different approach to the issue. People receiving ‘outpatient’ care from a community psychiatrist who are not otherwise known to the CMHT are classified as primary care service users. This means that people in the Western Vale who receive their care and treatment from a community psychiatrist and are not otherwise known to the CMHT do not have a right to a Care Coordinator, a C&T Plan or a part 3 right to self refer. There are ongoing negotiations about how such anomalies can be resolved.
15. Part 3 – A protocol for the timely assessment of former users of secondary mental health services has been presented to the Mental Health Programme Board for agreement. The protocol gives all former service users of secondary mental health services the right for up to three years following their discharge to refer themselves directly to the CMHTs without first going back to their GP. At November 2012, there has been no recorded direct self referral back to secondary mental health care. This is unsurprising, given that the right has only been in place since June 2012.
16. Part 4 - The LHB contract for Advocacy Services has been extended to 2013 with the current providers, South Wales Mental Health Advocacy. The contract is managed in collaboration with Cwm Taf LHB.
Relevant Issues and Options
17. For people with mental health problems, the Vale of Glamorgan provides social care services across two health board areas. The majority of people in the county are assisted by Cardiff and Vale University Health Board (C&V UHB) while people in the Western Vale continue to receive their secondary mental health care from Abertawe Bro Morgannwg University Health Board (ABMU) and their primary care mental health care from C&V UHB.
18. The Mental Health (Wales) Measure 2010 applies to adults of working age, older adults with mental health problems and adults with learning disabilities.
Resource Implications (Financial and Employment)
19. It is likely that future service developments will need to be met within reducing resources.
Sustainability and Climate Change Implications
20. There are no sustainability and climate change implications as a result of this report.
Legal Implications (to Include Human Rights Implications)
21. There are no specific legal implications as a result of this report. However the Vale of Glamorgan Council will continue to implement and adhere to the Mental Health (Wales) Measure 2010.
Crime and Disorder Implications
22. There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
23. The Mental Health Measure (Wales) 2010 extends the right to mental health care and treatment to all ages ensuring that all citizens have the same opportunity to receive the right care at the right time. However, the two health boards covering the Vale of Glamorgan have interpreted the legislation differently which may produce an inequality of service accessibility for residents of the Vale of Glamorgan.
24. To make the Vale a safe, healthy and enjoyable place in which individuals, children and families can live their lives to the full.
25. To Manage the Council’s workforce, money and assets efficiently and effectively in order to maximise its ability to achieve its service aims.
Policy Framework and Budget
26. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
27. There are no matters in this report which relate to any individual Ward.
Relevant Scrutiny Committee
28. Social Care and Health
Lance Carver, Head of Adult Services and Locality Manager
Andrew Cole, Operational Manager - Mental Health
Philip Evans, Director of Social Services